Grant: Health Sys. Impact Embedded ECR Award - Health Services, Health Systems & Policy

Cancer is the leading cause of death in Canada: two out of five Canadians are diagnosed with cancer in their lifetime, and one in four will die. There is growing evidence that important and inequitable variation exists in cancer access, quality and outcomes within Canada. Factors beyond disease biology - the social determinants of health (SDH) - can influence who gets cancer, what treatment they receive, and whether and how they survive. SDH are non-medical factors that influence health, and include the conditions in which people are born, grow, work, live and age. They are important mediators of health inequity, the unfair and avoidable differences in health between individuals and groups. In Canada, our understanding of how SDH impact cancer patients and how they contribute to differences in cancer outcomes is limited, especially at the individual and health system organization (HSO) levels. This is a barrier to developing effective, context-specific equity-orientated tools and interventions for patients and communities. The goal of this research program is to understand how individual-level SDH impact and mediate cancer outcomes (breast, colorectal, lung, gastroesophageal, pancreas, primary brain) for patients and to use this knowledge to better address SDH within clinical care, in order to improve cancer outcomes and enhance equity at the level of the HSO. This work is embedded within the Unity Health Toronto (UHT) HSO, with a partner site in Thunder Bay Regional Health Sciences Centre. Both sites serve cancer patients and communities that already experience disproportionate social, economic, geographic and structural disadvantage prior to diagnosis. The UHT HSO impact goal is to develop research and programmatic capacity within the UHT Department of Surgery that improves the care and outcomes of cancer patients experiencing SDH-mediated disadvantage, informed by local evidence.